ACP position paper offers recommendations to improve care for unhoused people
The recommendations range from funding programs to address immediate health care needs to improving access to affordable housing and providing medical education about these issues.
A new ACP position paper aimed at improving care and social needs of unhoused people offers recommendations for policymakers and physicians.
The paper was published by Annals of Internal Medicine on Feb. 27 and defines unhoused people as "those who lack a fixed, regular, and adequate nighttime residence." Individuals with unstable housing can include those who have trouble paying rent, experience overcrowding, move frequently, or spend the bulk of their household income on housing, the paper said.
The paper, drafted by ACP's Health and Public Policy Committee and approved by the Board of Regents on Feb. 20, includes eight recommendations to both prevent homelessness and promote health care for patients who are unhoused or have housing instability.
One recommendation is specifically directed at clinicians and medical educators. It calls on health care professionals to be knowledgeable about screening for and identifying symptoms of homelessness and approaches to treating unhoused patients throughout their training and career. ACP recommends homelessness and the underlying individual and structural issues related to homelessness and housing-based health inequities be incorporated into all levels of medical education.
In the recommendations, ACP notes that health is a human right and access to safe and affordable shelter is an essential component to implementing and recognizing that right. ACP calls for public policy efforts to prioritize facilitating safe and affordable housing for all and urges policymakers to address the drivers of homelessness and support and fund programs addressing the immediate health and shelter needs of this population.
An additional recommendation calls for an evidence-based and sustainable long-term national strategy to address homelessness that also recognizes and reflects local characteristics and conditions. As part of this, ACP supports research on interventions to address the needs of unhoused populations and to analyze the causes of homelessness.
ACP also supports Medicare and Medicaid demonstration projects that provide housing support and targeted medical services for unhoused people. Another recommendation supports laws decriminalizing symptoms of housing instability and homelessness to "allow unhoused individuals to undertake life-sustaining activities in public in the absence of available safe shelter while also sufficiently balancing greater public health interests." The paper notes that this is a short-term stopgap measure and should occur alongside long-term efforts to prevent homelessness.
Finally, ACP urges private and public payers to cover and provide payment for unhoused populations' health care services, and the College supports research and implementation of effective approaches to provide accessible care to patients.
"While undertaking system-level policy efforts to transform deficient societal conditions to promote and facilitate universal access to safe and stable housing, ACP affirms it is essential that policymakers and stakeholders simultaneously continue to fund and support programs that address the short-term, immediate needs of unhoused persons, including programs that provide shelter, subsidized housing, rent assistance, insurance coverage, and direct medical care," the position paper concludes.